Healthcare Provider Details

I. General information

NPI: 1225007917
Provider Name (Legal Business Name): RAMCHANDER RAO MADHAVARAPU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 EXCHANGE ST SUITE 202
ASTORIA OR
97103-3365
US

IV. Provider business mailing address

2120 EXCHANGE ST SUITE 202
ASTORIA OR
97103-3365
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-7337
  • Fax: 503-325-3706
Mailing address:
  • Phone: 503-325-7337
  • Fax: 503-325-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD25214
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier276048
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier1119858
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: